Individual provider Active NPI

Nathaniel D Tricker, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Charlottesville, VA
National Provider Identifier
1114903739
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
0401412914 Issued in VA
Practice address
244 Hydraulic Ridge Road
Central Virginia Oral & Facial Surgeons
Charlottesville, VA 22901
Phone
(434) 973-3348
Fax
(434) 977-5790
NPI assigned
Dec 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 12010200A IN
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DE00011016 WA
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 0401412914 VA Primary

Addresses

Primary practice location

244 Hydraulic Ridge Road
Central Virginia Oral & Facial Surgeons
Charlottesville, VA 22901

Mailing address

244 Hydraulic Ridge Road
Charlottesville, VA 22901
Phone (434) 973-3348

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Apr 20, 2017 through Apr 20, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
12010200AINMDOral and Maxillofacial Surgery (Dentist)
0401412914VAMDOral and Maxillofacial Surgery (Dentist)
DE00011016WAMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Central Virginia Oral & Facial Surgeons, PLC Oral and Maxillofacial Surgery Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282521600000",
    "number": "1114903739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 HYDRAULIC RIDGE ROAD",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "22901",
            "telephone_number": "434-973-3348",
            "fax_number": "434-977-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 HYDRAULIC RIDGE ROAD",
            "address_2": "CENTRAL VIRGINIA ORAL & FACIAL SURGEONS",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "22901",
            "telephone_number": "434-973-3348",
            "fax_number": "434-977-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRICKER",
        "first_name": "NATHANIEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2010-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12010200A",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00011016",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401412914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.